Changing the Pace of HIV Testing, One Local Pharmacy at a Time

Community-based testing could catch HIV infections early and offer patients access in places where health care is scarce.

For many Americans, access to health care is spotty, especially when
it comes to testing and treatment for those at risk for HIV/AIDS.

Researchers have found a potential solution to limited access—community-based care. A recent study from the Albert Einstein College of Medicine at Yeshiva University
in the Bronx, New York shows that community-based pharmacies can be
effective locations for offering rapid HIV tests and connecting those
who test positive with proper medical care on the spot.

While the HIV/AIDS epidemic may seem like a nightmare from the 1980s, the Centers for Disease Control and Prevention
(CDC) estimate that approximately 50,000 new cases of HIV infection
occur every year—and that number hasn't changed in over a decade.

“Despite
great gains in HIV treatment and care, there has been little change to
the annual incidence of HIV in the USA in 20-plus years. Much of the
public at risk for HIV is marginalized from health care due to poverty
and social barriers,” said study author Jason Leider, M.D., Ph.D., an
associate professor of clinical medicine at Albert Einstein. “Free HIV
testing in publicly acceptable sites like pharmacies brings the latest
testing diagnostics without impediment to the community."

By combining
these testing efforts with access to care for those who test positive,
it’s possible that the 20 percent of infected people who are unaware of
their HIV status can enter into treatment and avoid transmitting the
virus by accident, Leider told Healthline.

Community-Based Testing Takes to the Streets

Leider
and his colleagues partnered with five community-based pharmacies in
the Bronx and Manhattan, training public health advocates (PHAs) to
approach people in the pharmacies and on the sidewalks outside to offer
free HIV testing. The study ran for 294 days, during which time more
than 2,000 people agreed to be tested.

The PHAs used a rapid HIV
test, which produces results in 20 minutes, requiring only a swab of
saliva. While the participants were waiting, they filled out an HIV-risk
factor questionnaire and received counseling based on their answers. If
they tested positive, they were offered an immediate escort by the PHA
to a nearby HIV clinic where a trained specialist saw them less than an
hour after the diagnosis.

Six people tested positive, and five of
the six agreed to go with a PHA to an HIV clinic. After further testing,
it was revealed that all five had good CD4 counts of over 500 white
blood cells/mL, meaning that they were at a relatively early stage of
infection.

One of the benefits of a PHA, Leider said, is that they
can create a certain amount of comfort for clients and help turn
“getting tested” into something more routine—or at least less scary.
“Many people in the community stated there were no others providing
service. This was especially true among young [men who have sex with
men],” he said.

For some groups, community-based testing is ideal
and can catch HIV infection earlier than a more formal setting.
“Compared to patients testing in the medical setting, many more of the
pharmacy clients are younger, uninsured, and Spanish-only speaking.
People testing HIV positive in the pharmacy also had higher CD4 counts
than those in traditional medical settings,” Leider said.

HIV Testing, Aisle 4

There
still are some concerns among patients about privacy and safety in
community settings. Healthline's HIV Awareness communities on Facebook and Google+ weighed in about community-based HIV testing and care in pharmacies.

Facebook
user Cory B. said that it’s a “great idea but treatment/counselors
should be available at the time of testing.” David B. raised concerns
about privacy: “Unless there was a private room in which the test could
be administered, then fine. But a little ‘space’ in the corner like you
see at CVS & Walgreens where you go for medicinal
consultations—NO!”

For those living with little to no access to
HIV care, a community pharmacy could make all the difference. Google+
user Tim B., who lives in a rural area, has to drive a hundred miles to
get HIV medication, and often, the pharmacy he goes to runs out of
medication. “That is standard,” he said. “If there was a community
pharmacy, it would be sane. Today, it is insane.”

Leider agrees
that access to care is the name of the game. “This approach further
establishes pharmacies as true cornerstones of community health care
services,” he added. “Training about HIV prevention, testing,
counseling, risk reduction, and community engagement are key.”

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